What’s the impact of the court ruling in San Francisco?
As the San Francisco Chronicle reports today, the immediate impact is that Healthy San Francisco will not be able to extend to it full potential, restricting access for 26,000 middle-income San Franciscans. That’s the unforunate human impact of the decision. Whether it has a long-term impact on the financing of the rest of the program has yet to be seen, but it’s a concern.
But maybe not for long. There’s no guarantee of what will happen on appeal. As the Workplace Prof Blog sees it, “I expect an appeal to the Ninth Circuit where all bets are off and panel composition will be key.”
As for state health reform? A ruling on one type of health reform is a ruling on… one type of health reform. What was proposed in San Francisco is different in detail, structure, and scope from what is proposed at the state level.
It’s not a surprise that a George W. Bush-appointed judge with a background as a corporate lawyer struck down a San Francisco ordinance, based on a ambiguous federal law that this very judge quotes is a “veritable Sargasso Sea of obfuscation.”
Despite the fact that “the task of developing a clear rule to identify whether ERISA preempts a particular state law ‘has bedeviled the Supreme Court'”, this judge took an expansive view of ERISA pre-emption. But even in ruling against San Francisco and the labor unions who intervened, he keeps the door open, and proposed something that could pass muster:
He then describes the very structure in SB2/Prop 72 of 2004, and what is essentially what is expected to be part of the financing of AB x1 1: Assess all employers, but provide a credit/reduction for those who make health expenditures directly for their workers.
It’s unfortunate that the decision will impact San Franciscans trying to get care, at least until the appeal. But it shouldn’t impact state efforts, whether for AB x1 1 or SB840, and might even offer an opening…
(Largely cross-posted from a discussion at Calitics).